Speaking at a Health Affairs media breakfast this morning, Rep. Dave Camp (R-MI) did not offer much hope for the prospect of moving toward universal coverage, either now or in the foreseeable future. Camp, the senior Republican on the House Ways and Means Committee, offered a little heartburn for the insurance industry as well: He endorsed requiring insurers to cover Americans with pre-existing conditions but opposed an “individual mandate” requiring all Americans to have coverage.

Camp said Democratic health reform legislation was “dead” after voters in Massachusetts elected Republican Scott Brown to the Senate seat previously held by Edward Kennedy, giving Republicans the crucial 41st vote they needed to filibuster the legislation. Camp also laid out conditions that would seem to preclude making a serious dent in the ranks of uninsured Americans under any plausible approach.

“Clearly, we have to lower health care costs — those are spiraling out of control. And we must ensure every American can get affordable health care,” said Camp. But he added that “we must do this in a way that will not raise taxes, cut Medicare, or increase the deficit.”

Camp authored the Republican alternative to the Democratic health reform bill passed by the House last year. The Congressional Budget Office scored the Republican bill at a small fraction of the cost of the Democratic approach, but CBO also said Camp’s proposal would not reduce the percentage of Americans lacking health insurance.

At the breakfast, Camp explained that his bill was not meant to achieve universal coverage but was aimed at lowering health care costs. He described his legislation as part of step-by-step approach to health reform that Republicans had begun by passing the State Children’s Health Insurance Program, adding prescription drug coverage to Medicare, and giving a new emphasis to wellness and prevention efforts in the Medicare program.

Camp touted provisions of his bill that he said would reduce costs, such as malpractice liability reform and allowing the purchase of insurance across state lines. However, even if these and other cost-reduction measures were to work perfectly, moving toward universal coverage would likely still costs hundreds of billions of dollars.

Nevertheless, Camp refused to agree that some combination of increased taxes, Medicare cuts, or deficit increases would be required: “I wouldn’t say that, because I don’t know how effective some of these incentives might be. I think we want to see those in practice. So no, I wouldn’t accept that we have to do that.” Asked whether he was setting a double standard, since the Medicare prescription drug benefit was not paid for and therefore increased the deficit, Camp responded by criticizing accounting gimmicks — such as increasing taxes before coverage subsidies kick in — that he said demonstrated that Democrats were not really paying for their proposed health reforms.

Insurance Reforms

Camp voiced support for insurance reforms such as barring insurers from denying coverage to applicants with pre-existing conditions and imposing annual caps on coverage. However, he explicitly opposed an “individual mandate,” which would require all Americans to purchase health coverage. The insurance industry has said it would agree to cover all comers, including those with pre-existing conditions, but only in exchange for an individual mandate that would bring young and health Americans into the risk pool and prevent people from gaming the system by waiting to purchase coverage until they got sick.

Camp did not address whether he would allow insurers to charge higher premiums to those with pre-existing conditions, but he said he was “not a fan” of community rating, which would equalize premium rates for all comers, regardless of health status.

Medicare Commission

Camp said he opposed the creation of an independent Medicare Commission whose recommendations could only be overturned by Congress through a super-majority or special procedures. “One of the things people want is accountability. They want to have a part in this, and I think our representative democracy is how they want to do that,” he said.

When asked by Health Affairs Editor-in-Chief Susan Dentzer what he would do to avert the “fiscal train wreck in the making” represented by Medicare, Camp acknowledged that he did not have all the answers and said Congress should examine ways to deal with the program’s “daunting” long term liabilities. One small step, he said, is “to not terminate the one reform area of Medicare we have, which is Medicare Advantage, where they’re actually able to try some new things.” He added: “The care coordination that we are seeing in Medicare Advantage is positive, and we need to support that, not end it.”